<table>
	<tr><td height="10" colspan="4">Investigation Details:</td></tr>
	<tr valign="top">
		<td colspan="4">
			<fieldset style="border:1px solid gray;width:800px;">
			<legend style="padding:0.2em 0.5em;border:1px solid gray;color:#2C6193;font-size:13px;text-align:left;font-weight:bold;">X-RAY</legend>
				<table width="100%" cellspacing="0" cellpadding="3">
					<tr>
						<td style="margin-left:50px;" width="50px">ID</td>
						<td>Investigation Name</td>
						<td>Description</td>
						<td>Charges</td>
						<td>Option</td>
					</tr>
					<tr><td height="10" colspan="4"></td></tr>
					<tr>
						<td >1</td>
						<td><input name="testname1" type="text" id="testname1" value=""></td>
						<td><textarea name="description1" rows="2" cols="30"></textarea></td>
						<td><input name="testamt1" type="text" id="testamt1" value="" size="10"></td>
						<td>
							<!-- <img src="images/icons/add_new.png" width="30" height="30" > -->
							<img src="images/icons/delete.jpg" width="30" height="30" >
						</td>
					</tr>
					<tr><td height="10" colspan="4"></td></tr>
					<tr>
						<td>2</td>
						<td><input name="testname2" type="text" id="testname2" value=""></td>
						<td><textarea name="description2" rows="2" cols="30"></textarea></td>
						<td><input name="testamt2" type="text" id="testamt2" value="" size="10"></td>
						<td>
							<img src="images/icons/add_new.png" width="30" height="30" >
							<img src="images/icons/delete.jpg" width="30" height="30" >
						</td>
					</tr>
					<tr><td height="10" colspan="4"></td></tr>
				</table>
			</fieldset>
		</td>
	</tr>
	<tr><td height="10" colspan="4"></td></tr>
	<tr valign="top">
		<td class="desc" width="100" colspan="3">Remark Of Report:</td>
	</tr>
	<tr>
		<td colspan="3"><textarea name="remark" rows="3" cols="60"></textarea></td>
	</tr>
	<tr>
		<td colspan="4" height="10px"></td>
	</tr>
	<tr valign="top">
	    <td>
			<?php
			if( true == isset( $_GET['xray_id'] ) && true == valStr( $_GET['xray_id'] ) ) {
				echo "<input type=hidden name=operation value=update>";
				echo "<input type=submit value=UPDATE id=Submit name=Submit>";
			} else {
				echo "<input type=hidden name=operation value=insert>";
				echo "<input type=submit value=SUBMIT id=Submit name=Submit>";
			}
			?>
		</td>	
		<td  colspan="3" width="220">&nbsp;</td>
	</tr>
</table>